Grant Support: This study was funded by investigator-initiated grants (Dr. Solet) from the Academy of Architecture for Health, the Facilities Guidelines Institute, and The Center for Health Design. Sleep laboratory work was completed through the generosity of Massachusetts General Hospital and with acoustic consultation by Cavanaugh Tocci Associates.

Reproducible Research Statement:Study protocol, data set, and statistical code: Available from Dr. Buxton (e-mail, orfeu_buxton@hms.harvard.edu). Execution of a materials transfer agreement is required for the transfer of data.

Abstract

Background:

Sleep plays a critical role in maintaining health and well-being; however, patients who are hospitalized are frequently exposed to noise that can disrupt sleep. Efforts to attenuate hospital noise have been limited by incomplete information on the interaction between sounds and sleep physiology.

Objective:

To determine profiles of acoustic disruption of sleep by examining the cortical (encephalographic) arousal responses during sleep to typical hospital noises by sound level and type and sleep stage.

Design:

3-day polysomnographic study.

Setting:

Sound-attenuated sleep laboratory.

Participants:

Volunteer sample of 12 healthy participants.

Intervention:

Baseline (sham) night followed by 2 intervention nights with controlled presentation of 14 sounds that are common in hospitals (for example, voice, intravenous alarm, phone, ice machine, outside traffic, and helicopter). The sounds were administered at calibrated, increasing decibel levels (40 to 70 dBA [decibels, adjusted for the range of normal hearing]) during specific sleep stages.

Measurements:

Encephalographic arousals, by using established criteria, during rapid eye movement (REM) sleep and non-REM (NREM) sleep stages 2 and 3.

Results:

Sound presentations yielded arousal response curves that varied because of sound level and type and sleep stage. Electronic sounds were more arousing than other sounds, including human voices, and there were large differences in responses by sound type. As expected, sounds in NREM stage 3 were less likely to cause arousals than sounds in NREM stage 2; unexpectedly, the probability of arousal to sounds presented in REM sleep varied less by sound type than when presented in NREM sleep and caused a greater and more sustained elevation of instantaneous heart rate.

Limitations:

The study included only 12 participants. Results for these healthy persons may underestimate the effects of noise on sleep in patients who are hospitalized.

Conclusion:

Sounds during sleep influence both cortical brain activity and cardiovascular function. This study systematically quantifies the disruptive capacity of a range of hospital sounds on sleep, providing evidence that is essential to improving the acoustic environments of new and existing health care facilities to enable the highest quality of care.

Primary Funding Source:

Academy of Architecture for Health, Facilities Guidelines Institute, and The Center for Health Design.